Transcatheter Treatment of Tricuspid Valve Disease: An Unmet Need? The Surgical Point of View

Late Outcomes of Valve Repair Versus Replacement in Isolated and Concomitant Tricuspid Valve Surgery: A Nationwide Cohort Study

Background

Surgery for tricuspid valve (TV) diseases is associated with poor prognosis, but few studies have described the long‐term outcomes by comparing TV repair and replacement in isolated and concomitant TV surgeries separately.

Methods and Results

Between 2000 and 2013, adult patients who underwent TV repair or replacement surgeries were identified from the Taiwan National Health Insurance Research Database. Outcomes of interest included all‐cause mortality, composite outcome, and readmission attributable to any cause. Inverse probability of treatment weighting was used to reduce confounding effects. A total of 2644 patients with a mean follow‐up of 4.9 years were included. Of them, 12.6% and 87.4% underwent isolated and concomitant TV surgery, respectively. The in‐hospital mortality rates for isolated and concomitant TV surgery were 8.7% and 8.6%, respectively, whereas all‐cause mortality rates were 41.7% and 36.8%, respectively. Compared with TV replacement, TV repair demonstrated significantly lower risks of all‐cause mortality (concomitant: hazard ratio [HR], 0.76; 95% CI, 0.59–0.99), composite outcome (isolated: subdistribution HR, 0.55; 95% CI, 0.35–0.89; concomitant: subdistribution HR, 0.63; 95% CI, 0.46–0.86), and readmission (isolated: subdistribution HR, 0.64; 95% CI, 0.46–0.91; concomitant: subdistribution HR, 0.72; 95% CI, 0.60–0.86), except insignificant difference in all‐cause mortality in isolated surgery.

Conclusions

Compared with replacement, TV repair is associated with better short‐ and long‐term outcomes in both isolated and concomitant TV surgery. However, further prospective clinical trials are warranted.